August 2003 Bulletin

In Brief

From the States


The Physical Therapist Direct Access Bill passed only after it was amended to limit direct access to "wellness care." Other legislation was signed into law that stipulates which fields must be completed for a claim to be considered clean by an insurer under the Prompt Pay law.


In response to legislation introduced in the state to establish a $250,000 cap on non-economic damages, trial lawyers introduced legislation to limit the hours that residents can work and eliminate confidential peer review. A compromise reform bill without a cap passed on the last day of the session requiring that an affidavit of merit be filed with a suit signed by an expert who is board-certified in the same or a similar field as the defendant. The bill also allows plaintiffs to extend the statute of limitations for 90 days so they can investigate whether negligence occurred.


The Florida legislature met twice in special session to consider Gov. Jeb Bush's legislation to create a $250,000 non-economic cap. After a stalemate during the first special session, the House and Governor agreed to an overall $1 million cap with a $250,000 cap for physicians. The Senate is still pushing for a cap that could go as high as $6 million.


A bill passed both houses requiring that physicians see the fee schedule before signing an insurer contract.


A Physical Therapist Direct Access Bill passed both houses and became law without the governor's signature. The bill allows chiropractors to refer to PTs and allows them direct access "for a previously diagnosed condition…for which physical therapy services are appropriate after informing the health care provider rendering the diagnosis. The diagnosis shall have been made within the previous 90 days. The physician therapist shall provide the health care provider who rendered such diagnosis with a plan of care for physical therapy services within the first 15 days of physical therapy intervention." The bill also tries to limit the liability of the diagnosing physician for conditions that may arise after the physician's diagnosis.


The governor signed a bill requiring insurers to provide chiropractic coverage up to 26 office visits per year. He also vetoed a tort reform bill that would have tightened venue rules, required cases to be mediated, provided immunity for statements of apology and grief and lowered the cap on non-economic damages to $350,000, but kept it indexed to inflation.

New Hampshire

Legislation passed both houses and was signed by the governor to overrule a decision by the state Supreme Court that allowed plaintiffs to sue for "loss of opportunity" in medical liability cases.


The Senate rejected a proposed ballot initiative that would have gone before voters at the same time as doctor-backed initiative in November 2004. The physician community collected petitions to require the public to vote on a tough tort reform proposal. The doctors' initiative will strengthen the cap on non-economic damages that passed last year and will restrict lawyers' contingency fees. The bill before the legislature would have required the public to vote on the caps as they were enacted last year.


The Pennsylvania Orthopaedic Society, three individual orthopaedists and Independence Blue Cross (IBC) announced a preliminary settlement in the class action lawsuit involving the reimbursement policies of IBC. IBC agreed to disclose its fee schedule to providers, disclose payment policies and procedures, establish a process for provider appeals and process claims for multiple surgeries (and other procedures) according to "established standards." These changes could provide an additional $40 million to providers over the next two years.
Legislation passed the House that would allow voluntary binding arbitration in medical liability cases and also includes patient safety provisions.
Another House bill passed to amend the constitution to allow the legislature to cap non-economic damages. The proposed amendment must still be approved by the Senate twice, by the House once more and then by the votes.
A previous bill also included language requiring insurers to provide fee schedules to physicians and mandates that high-risk specialists get reimbursed at least at 110 percent of Medicare.


Gov. Rick Perry signed a bill providing immunity for physicians who provide school athletic physicals.
He also signed the prompt payment bill that allows the state by rule to declare what fields on the CMS 1500 form must be filled out for the claim to be considered clean.


The American Medical Association added Wyoming to its list of states facing a crisis in the medical liability insurance market; Wyoming is the 19th state to receive such a designation.

The AAOS has collected resource materials on the medical liability insurance crisis in the states, including state tort laws, the AMA crisis map, talking points, issue briefs and sample brochures.

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